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Three Part Question

IN [patients presenting with frozen shoulder]IS [exercise alone or exercise combined with manual therapy more effective] AT [reducing pain & improving function]

Clinical Scenario

A 50 year old woman is referred to physiotherapy with a diagnosis of frozen shoulder. There is a history of minor trauma. The pain is severe, & sleep disturbed. There is marked, global loss of range of movement actively & passively, especially external rotation.Serious pathgology has been excluded.Debate ensues as to the most effective way of improving pain & function in this patient group.

Search Strategy

AMED on DIAL DATASTAR interface 1985 - September 2008; CINHAL on DIAL Datastar interface 1950 - September 2008: Cochrane Library via National Library for Health.
MESH terms - Frozen shoulder OR patient education OR self care OR Exercise therapy AND Physical therapy AND massage AND reflex AND stretch AND tissue release AND accessory movements AND passive movements AND hydrotherapy AND manipulation And Chiropractic AND flexibility training AND hold relax.